Medicine

Medicine In Antiquity

It's usually thought that medicine appeared in Mesopotamia and Egypt during the 3rd millenium B.C. Some 800 tablets on medical matters including disease, diagnosis, prescriptions of drugs and magical spells for treatments are known from the Mesopotamians, constituted the first recorded references to medicine and the medical art. Sin was then considered to be a root cause of sickness, as confessions were a important feature of therapy as 6,000 evil spirits were also thought capable of causing disease. Mesopotamia healers were the priests and some persons closer to a nowadays physician as both roles could be assumed by a same person. Babylonians -- and Assyrians too -- perceived diseases as phenomena that were caused by gods, demons or witchcraft, as physicians-healers were dealing with. In Egypt, a form of medecine that had gotten rid of magics and tending to be logical appeared, some distance with the concept of sin-retributive disease. It was still related to religion however. It's likely due to the Egyptians that most of our medicinal herbs are originating, as through mummies, Egyptians surely were at the origin of anatomic knowledges. The physicians, at that time, in Egypt, were trained, they put diagnosis, they use various therapies, have customers or they are practising in medical centers. Imhotep, a high-ranking civil servant, architect of Pharaoh Djoser and designer of pyramids, a great priest and a poet at the same time, was too the icon of the Egyptian medics. As he eventually got the status of a god, it might that under its Greek name of 'Imouthes', he be at the origin of Asclepios, the Greek god of medicine. In Egypt, illness was however still considered like the body being possessed by supernatural forces. Ywti, the physician of Ramses I and Sethi II, states that the diseases are the consequence of the faulty operation of the bodies. And it is possible that the Sumerians had arrived at this same point of view. The pharmacopeia, although still marked by the superstition (one uses ingredients which disgusts the malignant spirits), will find oneself sometimes until the 18th century (droppings of fly and ostrich, excrements of lion, panther, crocodile and gazelle) whereas other products always have a recognized effectiveness like the mandrake, the brewers' yeast, the jusquiame, the poppy or opium. The Egyptians also had good knowledges in surgery, as one finds on the mummies the traces of correctly reduced fractures. Anatomical knowledge of the Egyptians is limited however: they do know the heart and the vessels, but they model the operation of them on that of the Nile. Medical knowledge, on the other hand, circulates badly due to problems of language -as far as the knowledge of the Chaldeans is concerned- or to that it's transmitted orally primarily. The clergy, at last, undoubtedly slowed down this development of a scientific vision of medicine, since its power and wealth relied on the fear of death and of the diseases. They connected both to gods only. Successes in the domain of surgery are due to the fact that the surgical act is a pragmatic one, and increasing by experiment, as it does not present the reasoned character of the medical knowledge. Hebrews, as far as they are concerned, engendered a focus on justice, compassion and loving kindness with concepts of divine retribution, purity/impurity, dietary laws, leprosy and contagion in terms of medicine

The discovery of medicine, more usually, is attributed to the Greeks albeit they first turned to divine causation. It's likely however that the most progress the Greeks made in the matter was due to that they gained contact with the Egyptian knowledges, under the Ptolemaic dynasty, this last dynasty of Egyptian rulers, which sprang out of a lieutenant of Alexander the Great. The Greek gods numbered a vast number of gods dealing with medicine however, like Zeus himself, his son Apollo, Asclepios, the son of him and the two daugthers of Asclepios, Hygieia, and Panacea, as it was the first philosophers who, starting in the 6th century B.C., began to set the ground for an evolution, as they dissociated medicine from magics. Pythagoras (who devised the theory of the four elements which are found back in the human body -earth, fire, water, and air), Thales or Democritus (who gave a classification of drugs) are such philosophers. The real, Greek, originator of modern medicine is Hippocrates (about 460-470 B.C.). His tenets were at the origin of the 'Hippocratic school of medicine.' He was interrogating and examining the patient, as he was practising too surgery and using various therapies (bloodletting, cautery, laxatives and vomit-inducing drugs, mineral, animal and herbal drugs). Hippocrates stated general principles of healing, under the name of 'aphorisms', which remained basic among physicians until the 18th century A.D.! He kept on with the theory of the four elements, which were associated to four states (warmth and fire, cold and water, dry and earth, wet and air, respectively) and with four humours (blood, phlegm, yellow bile, and black bile). He tended too to dissociate further medicine from religion, as, originating in a family of priest-medics of the Greek god Asclepius, he will attend the teachings of Democritus. His mootto was, in Latin, 'primum non nocere' ('first, do not harm') as the first aphorism was: 'Life is short, medecine art is vast, experiment is deceitful, as opportunity is elusive'. Both such statements are famous as they are at the fundation of the art of healing. Among the Greeks, medicine and philosophy always were close together. During 15 centuries however, bleeding and enema remained the two basic therapies

Plato (428-348 B.C.) added to medicine the concept of 'pneuma', a kind of vital breath which allows the general work of body's parts. 'Pneuma', at the same time, is partly air and partly fire. Aristotle, as far as he is concerned, just was interested in zoology, as, from the dissections he made on animals, he brought some discoveries in anatomy. The Ptolemaic dynasty in Egypt, at last, will allow physicians to operate first dissections on human corpses, as the discoveries made then will remain ill-known, the medics of that time keeping being suspicious to that new branch

Greek medical knowledges, then, passed to the Romans, this new power which has conquered the Mediterranean world. Romans had came back to beliefs in divine retribution with pilgrimages to some 732 temples and shrines is showing how Romans kept healing cults associated with specific gods and goddesses. Until then, only barbers and slaves were acting like medics. Rome was to yield two great physicians, Celsus -in the 1st century A.C- and Galen -in the 2nd century A.C. Celsus authored the first comprehensive medicine book, as he classified illnesses into those which may be cured by a mere diet, those which may be cured by drugs and those needing surgery. Galen, on the other hand, streamlined medicine along the concept of organ. According to him, each disease is to be linked to an organ being injured. Thus he founded the 'organicist medicine'. He kept however the theory of the four elements and humours, as he further linked them to four 'tempers' or dispositions. His fame became such that the fact he got not interested into surgery will disparage that sector of medicine until the Renaissance. As he had been born in Pergama, in Asia minor he travelled along the Mediterranean for training, he turned the physician to the gladiators of the city and then the one to Marcus Aurelius, the Roman emperor and philosopher. He studied philosophy during 14 years as he advocated harmony between physical and the moral health. He also was a famed drugist as he discovered the 'galenic preparation,' which allows for the stability of drugs. On a other hand, has he always turned back to the Greek language to write his treaties, Galen also was at the origin of the overuse of Greek terms in medicine, until nowadays included. Galen took back the Greek tradition of the proximity between medicine and philosophy. It's in Rome, at last, that the first known hospitals -for veterans and the disabled- appeared, as the sense of the public hygiene developed with public fountains, sewers, public toilets, baths, etc). Generally some argue that one may consider that since Antiquity, human and animal (veterinary) medicine walked together and enriched both mutually. Early Christianism sanctified sickness with medical philanthropy in the Early Church, as it was at the origin of the hospital

From Byzantium to the Carolingian Empire

Medicine, by the end of the Roman empire and during the early Middle Ages, passed from Rome to Constantinople and Byzantium, as it gave birth to numerous advances along with theoretical works (Oribase (325-403) wrote an encyclopedia and several books about pharmacopoeia; Alexander of Tralles, or Paul of Egin -who died in 690). Hospitals, in the cities of the Byzantine empire, are hosting the sick. As far as the West is concerned, the Fathers favored Galen due to his monotheistic views. When the Arabs conquered the estern Mediterranean, those knowledges, like many in other domains too, passed to them as the Arabs found too the data of the ancient Greek medicine in the Byzantine regions they conquered. The first well-known Arab such physician is Abu Bakr Muhammad Ibn Zakaria ar Rasi -or Rhazes. He was describing diseases, by the end of the 9th century A.D. (gout, kidney stones, smallpox or measles) as his pupils was to have his teachings into an encyclopedia, the 'Continens.' In Islamic dominions, by the Middle Ages, the link between divine and natural causation was clearly formulated, Allah seen as the first cause of healing because he bestowed powers on medical substances for therapy. Avicenna was the next famed physician of the Arabic world. In Islam, closer to medicine may be brought the concept of 'occult diseases,' which suppose to be cured by a exorcism -- the 'ruqiya' -- a exorcism through the recitation of Qur'anic verses and the use of substances such as water, oil, honey, medicinal herbs, etc.; it's about undoing the effects of magic ('sihr') and exorcising demons. In addition, Surahs 113 and 114 are called 'talismanic souras' and are recited together against witchcraft and 'jinns.' Belief in jinn, and other spiritual beings, is widespread among Muslims. Finally, in pre-colonial Algeria, white-heated iron bars were applied to parts of the body with a problem, as exorcisms still today in Muslim world, are part of a wider body of contemporary Islamic alternative medicine called 'prophetic medicine.' Jews also played a role in the tranmission of medicine of Antiquity: medicine was to be one of the few activities allowed to Jews after the Second Exile. Jewish doctors were part of their environment and because of the links between Jewish communities, they passed on the Antiquity's medical heritage. Famed rabin Makir in Narbonne, in the Carolingian times, brought the knowledge of Asaph of Tiberias (6th century A.D.) which was also to be spread elsewhere (in the 10th century, in Cairo and Kairouan or Salerno and Palermo). Jewish doctors were gradually incorporated into the Arab world and practiced there -some at the caliphate court - and yielded writings. Of particular note was Isaac the Jew or Israeli (855-950), a doctor of the Fatimid Caliph of Kairouan (his works were also taken back to Salerno). In Spain, Jewish doctors enjoyed 5 centuries of prosperity. As far as the Western world is concerned, the Church was not meant to be interested into medicine as it was of course giving its preference to a 'theological' view of illnesses, hence preferring to root them out in terms of sin. It's the Church however which, through the preservation of the works from the Antiquity, is the one which helped transmitting the medicine into the Middle Ages, like a rational approach of diseases

Hygiene and dietetics may override actual medicine by the Carolingian times. Weekly bath was of custom among the Greats as baths are found in or near the monasteries. In their medical function, monasteries practiced regularly bloodletting ("flebotomia"), including for monks and they used a book of Bede to know what are the days favourable to it. Carolingians times moreover practiced dietetics. They used treaties of the lower Empire or the Merovingians like the 'De Observatione ciborum' of Anthyme a doctor who wrote it for King Thierry. People took care of what they ate as calendars specified different cares depending on the season and months. Purges, baths, and exercises were part of advices. Doctor intervened, in fact, only in case of serious illness and a secular, cleric, or Jew doctor served princes as abbots and bishops, because of their knowledge, could do that office. Already at the time, even if the discipline of medicine is found in the programs of clerical studies, Canon law, due to not shed blood, banned the practice of medicine to the clerics. For some scholars, medicine was the eighth liberal art as copied medical manuscripts from the Ancients are know, like Hippocrates, Galen, Soranus, Heliodorus, Justus, Marcellus Empiricus, or Oribase. Laon was a active center for medical studies. Knowledge remained poor however, compared to Byzantine or Arab medicine and veterinary medicine or magic formulas interfered in treaties. Saints' tumbs serving like places of pilgrimage and healing are locations where descriptions of medical symptoms are written. Gynecology is a important part while surgery knew instruments and operations, which were used to treat combat wounds. Infant mortality, famine for cause of agricultural calamities, and 'pestilences' were the main causes of mortality under the Carolingians. The plague, which raged in the West until the middle of the 8th century A.D., is no longer active

->Medicinal Herbs
The interest of the Frankish empire into the medicinal herbs, on another hand, is another remarkable fact. As they are grown in each monastery's garden, the herbs are even the object of an important passage of a capitulary, the famed capitulary 'de Villis', this legislative document which, by the end of the 8th -or the beginning of the 9th centuries- specifies how villae and domains are to be managed. Although it's still badly known whether this text apply to the domains in the whole of the Frankish world, or in Aquitaine region only, it's evoking 73 herbs to be planted in the domains, like alexanders, anise, caraway, catmint, centaury, chervil, chives, clary, coriander, costmary, cumin, black cumin, dill, dragons (tarragon), fenugreek (Greek hay), houseleek, lovage, mint, horse mint, wild mint, mustard, parsley, pennyroyal, rosemary, rue, sage, or savory. As herbalism was already known by the ancient Egyptians, used by Hippocrates, and as herbs were described into 600 species by Dioscorides -a Greek surgeon in the armies of the Roman emperor Nero- herbs -along with products taken from animals, were one of the fundamental basis for therapy in all the ancient civilizations in the world -in the West, China, or India, for example. In the new Europe, which appears from the fall of the Roman empire, herbs don't appear back in medicine before about the year 600, in the monasteries. Any garden there, then, along with vegetables, tinctorial and aromatic herbs and plants, and fruits, the medicinal herbs. Health cares are provided by monks, as they even accept to disclose some of their herbal receipts. This bringing to some kind of folk medicine, with each villagers family growing its own herbs. Active agents of medicinal herbs are often part of how the deal with their predators, like microorganisms, insects or herbivores. Those herbs, which, by the 12th century eventually will form the fundamentals of the western medicine, are originating into three traditions -the one of the Greek and Roman world, the herbal knowledge from India, and the traditional herbalism healing from China. St. Gall used 16 varieties of medicinal plants as certain times of the year are recommended for the use of such plant. A poem by Walafrid Strabo described the properties of some plants. Pepper and other spices were used in combination with medicinal plants. Following a antique tradition, they also knew, among other herbs, those which had a narcotic and pain-attenuating effect, like for example, the Hyoscyamus niger, commonly known as henbane

The good acceptance, for a while, of the jewish communities and the Jews who were the link to the Muslim Spain, in the Empire made that -albeit with some delay, about the 8th and 9th centuries- the knowledges by some great Jewish medics came to be spread into, like Assaf ha Rofé ("Remedies"), Isaac ben Salomon -also "Isaac Judeus" (850-932, philosopher and medic, "The Book of Remedies", "The Book of Fever", et "Ethics of Medics"). Such Jews in Al-Andalus, are mixing the Arabic culture and the Greco-Roman one. Sabbataïl ben Abraham ben Joël Donolo (913-963) is another great medic, in Italy, in an era when the School of Salerno -the first medical school ever in Europe, in Salerno, South of Naples, Italy- already is existing as it had been founded in 850. That likely originated from a demand of local elites to medical knowledge which was fulfilled by Constantine the African, a merchant from Ifriqya (current Tunisia), to turned translator of Arabic works in the domain and was falsely considered the author of them

Medicine was to remain Arab or Arabo-Spanish until the 13th century as texts and concepts -among others the ones of Galen- were passed to the West through Arabic physicians -of them the famed Ibn Sina, or Avicen. Both main Faculties of Medecine, in Europe at the time, were Paris and Montpellier. The school of Salerno, in the 11th century, under the Norman rule, had became too a lay and multi-cultural center for the teaching of medicine. The following main turn in the history of medicine took place by the Renaissance. At that time, as physicians began to venture into human dissections, Vesalus dared question Galen as the observations made on the basis of his works were inconsistent with those. Medicine began to see its rational emancipation as it was Willian Harwey who made medicine pass into experimentation. Medicinal herbs, as far as they are concerned, are keeping until today to be used in the art of healing. The scientific revolution however brought to that just their active elements are used, mainly, like the case in opium, quinine, digitalis, or aspirin). After the Carolingian era, the Church came back to a more wary approach to the medicine as it tended to forbid its use by clerics, for cause of that the patients were at risk of death, and it framed it with strict rules. Protestantism and Enlightenment medicine, despite Tridentine Catholicism marked the Modern era through secularizing tendencies of medicine considered a science. On a other hand, while knowledge in anatomy and physiology increased at the time, conventional healing made little use of it as Galenic therapeutics continued to be widely used until the early nineteenth century. Science in medicine kept its development until now, with more efficient drugs and therapies or chirurgical practices, etc.